Editing Teething (section)

==Signs and symptoms==
The level of pain that a baby can handle will be different for each child. Some may appear to suffer more than others while they are teething. The soreness and [[swelling (medical)|swelling]] of the [[gingiva|gums]] before a tooth comes through is the cause of the pain and fussiness a baby experiences during this change. These symptoms usually begin about three to five days before the tooth shows, and they disappear as soon as the tooth breaks the skin.<ref>[http://www.webmd.com/oral-health/tc/teething-topic-overview Teething Overview] WebMD. Retrieved on 2010-01-25</ref> Some babies are not even bothered by teething.

Common symptoms include [[drooling]] or dribbling, increased [[chew]]ing, mood changes, irritability or crankiness, and swollen gums. Crying, [[insomnia|sleeplessness]], restless sleep at night, and mild fever are also associated with teething.<ref>{{Cite journal|last1=Macknin|first1=Michael L.|last2=Piedmonte|first2=Marion|last3=Jacobs|first3=Jonathan|last4=Skibinski|first4=Christine|date=2000-04-01|title=Symptoms Associated With Infant Teething: A Prospective Study|url=https://pediatrics.aappublications.org/content/105/4/747|journal=Pediatrics|language=en|volume=105|issue=4|pages=747–752|doi=10.1542/peds.105.4.747|issn=0031-4005|pmid=10742315|s2cid=24601644 |url-access=subscription}}</ref> Teething can begin as early as 3 months and continue until a child's third birthday.<ref>[https://www.kutekeiki.com/teething/when-do-babies-start-teething/  When do Babies Start Teething?] Kute Keiki. Retrieved on 2019-09-15</ref> In rare cases, an area can be filled with fluid appearing over where a tooth is erupting and causing the gums to be even more sensitive. Pain is more often associated with the eruption of molars since they are larger, and do not penetrate through the gums as easily as the other teeth.

Some noticeable symptoms that a baby has entered the teething stage include chewing on their fingers or toys to help relieve pressure on their gums. Babies might also refuse to eat or drink due to the pain. Symptoms will generally fade on their own, but a doctor should be notified if they worsen or are persistent. Teething may cause signs and symptoms in the mouth and gums, but does not cause problems elsewhere in the body.<ref>[http://mayoclinic.com/health/teething/FL00102  Infant and toddler health] Mayo Clinic. Retrieved on 2010-01-25</ref>

Pulling on the ears is another sign of pain: the pain in the mouth throbs throughout the baby's head, so they pull their ears believing that it will provide relief. Mild [[rash]] can develop around the mouth due to the skin irritation caused by excessive drooling or dribbling.<ref>[http://www.emedicinehealth.com/teething/page2_em.htm#Teething%20Symptoms  Teething Symptoms] eMedicine Health Portal. Retrieved on 2010-01-25</ref>

===Sequence of appearance===
[[File:TemporalTeethDeveploment.gif|200px|thumb|right|Stages of tooth emergence, at 0 months, 6 months, 9 months, 12 months, 2 years, 3 years, 4 years and 5 years.]]
The infant teeth tend to emerge in pairs – first one lower incisor emerges, then the other lower incisor, after which the next set begin to emerge. The general pattern of emergence is:
# Lower central [[incisor]]s (2) at approximately 6 months
# Upper central incisors (2) at approximately 8 months
# Upper lateral incisors (2) at approximately 10 months
# Lower lateral incisors (2) at approximately 10 months
# First [[Molar (tooth)|molar]]s (4) at approximately 14 months
# [[Canine tooth|Canines]] (4) at approximately 18 months
# Second molars (4) at approximately 2–3 years

[[Deciduous teeth|Milk teeth]] tend to emerge sooner in females than in males. The exact pattern and initial starting times of teething appear to be [[hereditary]].<ref>{{Cite journal|last1=Maheswari|first1=N. Uma|last2=Kumar|first2=B. P.|last3=Karunakaran|last4=Kumaran|first4=S. Thanga|date=August 2012|title="Early baby teeth": Folklore and facts|journal=Journal of Pharmacy & Bioallied Sciences|volume=4|issue=Suppl 2|pages=S329–S333|doi=10.4103/0975-7406.100289|issn=0976-4879|pmc=3467875|pmid=23066283 |doi-access=free }}</ref> When and how teeth appear in an infant has no bearing on the health of the child.

===Misdiagnosis as teething===
Teething has not been shown to cause fever or diarrhea;<ref>{{cite book |title=Emergency Medicine: A Comprehensive Study Guide |edition=6th |last=Tintinalli |first=Judith  |year=2004 |publisher=McGraw-Hill Professional |isbn=0-07-138875-3 |page=1483 }}</ref> however, the belief that teething causes fever is extremely common among parents.<ref name="wiley28">{{cite journal | doi = 10.1111/j.1601-5037.2009.00412.x | title = Challenging parental myths regarding their children's teething | year = 2010 | last1 = Owais | first1 = AI | last2 = Zawaideh | first2 = F | last3 = Bataineh | first3 = O | name-list-style = vanc | journal = International Journal of Dental Hygiene | volume = 8 | pages = 28–34 | pmid = 20096079 | issue = 1}}</ref> Whilst there is some evidence that teething can cause an elevated temperature, it does not cause [[fever]] (medically defined as rectal temperature greater than {{convert|100.4|F|C|sigfig=3}}). One small 1992 study found a significant rise in temperature on the day of eruption of the first tooth.<ref name="autogenerated234"/> Another study in 2000 found "mild temperature elevation" but not fever over {{convert|102|F|C}}.<ref>{{cite journal | pmid = 10742315 | year = 2000 | last1 = MacKnin | first1 = ML | last2 = Piedmonte | first2 = M | last3 = Jacobs | first3 = J | last4 = Skibinski | first4 = C | name-list-style = vanc | s2cid = 24601644 | title = Symptoms associated with infant teething: A prospective study | volume = 105 | issue = 4 Pt 1 | pages = 747–752 | journal = Pediatrics | doi = 10.1542/peds.105.4.747}}</ref>

There is a risk that fever around the age of teething is dismissed as due to teething when it is actually due to illness, particularly infection by herpes viruses. "Coincidentally, primary tooth eruption begins at about the time that infants are losing maternal antibody protection against the herpes virus. Also, reports on teething difficulties have recorded symptoms which are remarkably consistent with primary oral herpetic infection, such as fever, irritability, sleeplessness, and difficulty with eating."<ref name=pmid1323823>{{Cite journal | pmid = 1323823 | year = 1992 | last1 = King | first1 = DL | last2 = Steinhauer | first2 = W | last3 = García-Godoy | first3 = F | last4 = Elkins | first4 = CJ | name-list-style = vanc | title = Herpetic gingivostomatitis and teething difficulty in infants | volume = 14 | issue = 2 | pages = 82–85 | journal = Pediatric Dentistry}}</ref> "Younger infants with higher residual levels  of antibodies would experience milder infections, and these would be more likely to go unrecognized or be dismissed as teething difficulty."<ref name=pmid1323823/> Herpes virus infection may take the form of [[primary herpetic gingivostomatitis]] (HSV-1)<ref name="wiley28"/><ref>{{cite web|url=https://www.drugs.com/cg/primary-herpetic-gingivostomatitis-in-children.html |title=Primary Herpetic Gingivostomatitis In Children |publisher=Drugs.com |access-date=December 18, 2011}}</ref> or of infection by [[human herpesvirus 6]] (HHV-6), which infects 90% of children by age 2.<ref>{{cite journal | doi = 10.1056/NEJMoa042207 | title = A Population-Based Study of Primary Human Herpesvirus 6 Infection | year = 2005 | last1 = Zerr | first1 = Danielle M. | last2 = Meier | first2 = Amalia S. | last3 = Selke | first3 = Stacy S. | last4 = Frenkel | first4 = Lisa M. | last5 = Huang | first5 = Meei-Li | last6 = Wald | first6 = Anna | last7 = Rhoads | first7 = Margaret P. | last8 = Nguy | first8 = Long | last9 = Bornemann | first9 = Rena | last10 = Morrow | first10 = Rhoda Ashley | last11 = Corey | first11 = Lawrence | journal = New England Journal of Medicine | volume = 352 | issue = 8 | pages = 768–76 | pmid = 15728809| display-authors = 8 | doi-access = free }}</ref> "The symptoms of elevated temperature and facial rash could be explainable by infection with the HHV-6 agent, which is ubiquitous among infants of teething age."<ref>{{cite journal | doi=10.1038/sj.bdj.4801349 | title=Teething troubles? | year=2002 | last1=McIntyre | first1=GT | last2=McIntyre | first2=GM | name-list-style = vanc | journal=British Dental Journal | volume=192 | issue=5 | pages=251–5 | pmid=11924952| doi-access=free }} Citing {{cite journal |vauthors=King DL |title=Teething revisited |journal=Pediatric Dentistry |year=1994 |volume=16 |issue=16 |pages=179–182|pmid=8058540 }}</ref> Other viruses{{example needed|date=December 2018}} may also cause fevers which might be misattributed to teething,<ref>{{cite web |last1=Davis |first1=Jeanie Lerche |title=Teething vs. Illness: How to Tell the Difference |url=http://www.webmd.com/oral-health/news/20000410/babies-teething-illness |website=[[WebMD]] |access-date=14 October 2015}}</ref> but the oral involvement that may occur with herpes viruses makes misdiagnosis a particular risk for such infections.<ref>{{cite web |url=https://www.kutekeiki.com/teething/can-teething-cause-fever/  |title=Can Teething Cause Fever? |website=Kute Keiki |date=20 April 2018 |access-date=21 March 2023}}</ref>